The present invention relates to finger-mountings for surgical instruments for use in both open and endoscopic surgery. The invention also relates to such finger-mountable surgical instruments.
In an open surgery procedure, an incision is made through the skin, and the tissues overlying the surgical site are retracted in order to expose an area large enough to allow for access and orientation by direct vision. The surgeon may use a wide range of instruments to perform the specific procedure, and may also use the surgeon's fingers to touch organs and receive tactile feedback. However, fingers lack the delicacy to pick up fine tissue; they require making larger divisions when dissecting tissues; and they are subject to injury when holding tissue if sharp instruments or energy modalities, such as ultrasound or RF, are used in the treatment at the surgical site.
In recent years, more and more procedures are being performed endoscopically. Endoscopy is a minimal invasive surgical procedure in which illumination, cameras and surgical tools are inserted into the patient's body via small incisions through the skin, and are manipulated externally, guided by the image displayed on a TV monitor. For the patient, trauma is minimized, and healing time and length of stay in hospital are shortened. Particularly, laparoscopy—endoscopy in the abdominal cavity—is being widely used both for diagnosis and for performing full surgical procedures.
However, several difficulties are inherent in this technique. Thus, considerable skill and experience are required to position the instruments spatially relative to internal organs while viewed in a two-dimensional monitor. Also, the field of vision displayable on the monitor is narrow making orientation even more difficult. In addition, it is hard to control the instruments because of their length, which is typically about 350 mm from the handles outside the body to the tip that actually performs the operations within the body cavity; this length is needed to reach the organs within the abdomen when the cavity is insufflated as required by the technique. Moreover, direct contact between the organs and the surgeon's hand is not possible, so that tactile feedback is lost.
Recently, a modified laparoscopic technique has evolved which is referred to as Hand-Assisted Laparoscopic Surgery (HALS), in which one hand of the surgeon has access to the body cavity while maintaining insufflation. This technique, as described for example in U.S. Pat. No. 5,640,977 to Patrick Leahy et al, is now an alternative procedure of choice. As only a relatively small additional incision is required, just sufficient for admitting the surgeon's hand, the advantages of minimal invasiveness are preserved. For the surgeon, less training is required because the presence of his/her hand in the body cavity allows palpation of internal organs, biophysical feedback, and easier manipulation of various instruments within the body cavity while viewing the TV monitor.
With the advancement of the HALS technique, a need arose for instruments which could be mounted directly onto the fingers of the hand within the body cavity, i.e., the “ported” hand. Miniature forceps, graspers, scissors, dissectors, probes, retractors, etc., modeled on existing instruments used in open surgery and mounted on the surgeon's finger, could perform delicate surgical tasks and aid the laparoscopic instruments introduced through the “keyhole” incisions. Obviously it would be advantageous to provide such instruments for use in open procedures as well as in “keyhole” procedures.
Several such instruments were suggested in U.S. Pat. No. 5,925,064 to Meyers et al, and US Application 20040193211 to Voegele et al. However, all the instruments described therein must be fixed to the finger outside of the body. Therefore, in HALS procedures the hand must be withdrawn through the port for changing instruments, which limits the advantages possible by this procedure.